Can’t I Take a Pill and Feel Better? Mental Health, Medication and Money

When we feel sick, we go to the doctor, get some medicine and generally feel better. It wasn’t always like this. If you lived more than about 200 years ago and you went to the doctor, they’d likely drain your blood, apply leeches, make you vomit and inflict various other treatments that were at best ineffective, and at worst, life threatening. It was only when doctors started applying the scientific method that they began to figure out what was helping their patients and what was killing them.

And what progress was made! Disease after fatal disease was banished, becoming a minor irritation or even, in some cases such as smallpox, vanishing entirely from the face of the earth. Sure, there are stubborn holdouts, ranging from the common cold to cancer, but you’ll be hard pressed to find a sensible member of western society who doesn’t believe that with enough time and money we will find cures for these too.

And modern medicine was called on to apply its wizardry to our mental health too. Just as bubonic plague and whooping cough have been defeated, so too would the evils of depression, anxiety, schizophrenia, psychosis, obsessive-compulsive disorder and the like. The problem is, when you look at the brains of people with any kind of psychological problem, you can’t find anything physical that caused it. So, unlike physical illnesses, there’s no invader to kill, no structural defect to remedy, nothing to cut out surgically. (Although a Portuguese doctor did some inventive but unpleasant things to people’s brains using a needle with a wire loop at the end, and won a Nobel Prize in the process. In a case of perhaps divine retribution, he was shot multiple times by one of his patients and never walked again.)

Since there was nothing to cut, and nothing to kill when it came to mental illness, medicine looked to the pharmaceutical industry to come up with drugs that would change brain chemistry and therefore change emotions and behaviors. And the pharma industry rose to the challenge starting in the 1950’s, churning out generations of antidepressants, anti-anxiety meds, anti-ADHD’s and anti-psychotics. These corporations have led the charge to free the world of mental illness.

Except that it hasn’t quite worked out. If these drugs were so effective, why are so many people still depressed and anxious? Why do so many people still suffer terribly from schizophrenia? Why are more and more kids diagnosed with ADHD?

It seems that there are two big problems with drugs and mental health: The profit motive, and the placebo effect. Let’s take them in turn.

The Profit Motive. Parma companies have to make as much money as they can. To do that, they need drugs that are both safe and effective. But drugs are not silver bullets that perfectly target the problem with pinpoint accuracy and without side effects. Virtually every drug has limits to its effectiveness, and issues with safety. So pharma companies are caught in a dilemma: The more they highlight issues with effectiveness and safety, the less money they’re going to make. Consumers will shy away from their products, and regulatory agencies will limit the use of those products. CEO’s will be fired, board members replaced, companies acquired.

And so the pressure to cut corners and minimize risks becomes irresistible. Data showing that the drugs don’t work very well — or at all — is buried, or manipulated to show the opposite. Negative side effects are minimized. Harm from long term usage, addiction potential and withdrawal is ignored. And the drugs are promoted aggressively. Consumers and even doctors get the message that drugs are safe and effective, and pharmaceutical sales boom.

The Placebo Effect. When we take medication that doesn’t work, but we feel better anyway, that’s the placebo effect. Your mind expects the drugs to help, and a combination of psychological and physical responses cause you to feel better. While placebos don’t work well with physical illnesses — sugar pills don’t cure cancer or heal broken bones — they have a big impact on many types of psychological issues. It turns out that when you give a depressed person a pill, and you tell them this is a powerful antidepressant and will make them feel better, many people do indeed feel better. Even if the pill is nothing but sugar. This misleads researchers, which is why there are always new reports of some new breakthrough treatment hitting the headlines. (The latest include magic mushrooms and MDMA for depression.)

Why is this important? Well, if you’re testing a new cancer drug, you have hard evidence to see whether it works: the tumor goes away, and you can be sure it’s not the placebo effect. But if you’re testing an antidepressant, it can be very hard to disentangle the effect of the drug from the effect of the placebo. And because of the profit motive, it’s not really in the interests of the drug companies and many other parties to disentangle those effects. Does anyone want to find out that a new drug that’s potentially worth billions is no more effective than sugar?

So can we just take a pill and feel better? It’s certainly in the interests of the pharmaceutical industry to convince you that the answer is yes. The truth is that psychoactive drugs are a lot less effective, and a lot less safe than we’ve been led to believe. In other articles I've discussed antidepressants and the placebo effect, the effectiveness of the other major classes of drugs, and how the research has become tainted -- have a look at them if you want details on how we've been misled.